[Cavernous sinus dural arteriovenous fistula complicated by edematous cerebral lesions from venous etiology]. / FISTULE ARTERIOVEINEUSE DE LA LOGE CAVERNEUSE COMPLIQUEE DE LESIONS CEREBRALES OEDEMATEUSES D'ORIGINE VEINEUSE.

The authors report the case of a 38-year-old woman with a cavernous DAVF resulting in edematous lesions located in the territory of the ipsilateral basal vein. Transarterial embolization led to subtotal regression of the fistula associated with the regression of cerebral abnormalities. The authors discuss the pathophysiology of the cerebral edematous lesions and the therapeutic consequences according to the venous drainage of the cavernous sinus.

Amalgam or composite resin? Factors influencing the choice of restorative material.

OBJECTIVES: This study aimed to investigate the patient and tooth factors associated with selection of restorative material in direct posterior restorations in young adults from a population-based birth cohort. METHODS: A representative sample (n=720) of all 5914 births occurring in Pelotas in 1982 were prospectively investigated, and posterior restorations were assessed in 2006, when the patients were 24 years old. Tooth-related variables (individual level) included restorative material (amalgam or composite), type of tooth, size of cavity, and estimated time in mouth. Data regarding demographic and socio-economic characteristics, oral health, and service utilization patterns during the life course were also assessed (contextual level). RESULTS: Logistic Regression Multilevel models showed that individuals who have accessed dental services by private insurance by age 15 [odds ratio (OR)=1.66 (0.93-2.95)] and who had a higher dental caries index at age 15 (high DMFT tertile) [OR 2.89 (1.59-5.27)] presented more amalgam restorations in the posterior teeth. From tooth-level variables, the frequency of amalgams decreases with increasing number of surfaces enrolled in the cavity preparation (p<0.001) and was almost 5 times greater in molars than in premolars. CONCLUSIONS: The present findings suggest that variables related to type of dental service, dental caries (higher DMFT index), and cavity characteristics (tooth type, size) determine the choice of dentists for restorative materials. Other individual characteristics such as demographic and socioeconomic status have not influenced this choice. CLINICAL SIGNIFICANCE: This is the first population-based study that assesses the determinant factors for the choice of dentists for composite or amalgam in posterior direct restorations, showing that, independently of socioeconomic and demographic characteristics, type of payment of dental services and clinical factors are associated with this choice.

O uso da fenil-hidantoina no controle de convulsoes eclampticas refratarias a tratamento. / Use of phenylhydantion in the control of eclamptic convulsions refractory to treatment

Foram analisadas 54 pacientes eclampticas com convulsoes rebeldes a tratamento, objetivando-se o estudo da fenil-hidantoina como droga anticonvulsivante. Quarenta e seis pacientes receberam a associacao de clorpromazina-fenotiazina como primeira terapeutica sedativa sem sucesso; destes 46 casos, 17 pacientes receberam um segundo tratamento anticonvulsivante (oito casos receberam pentobarbital, sete receberam diazepam e dois casos tiveram sulfato de magnesio). Estas 46 eclampticas entraram no estudo junto com mais seis pacientes que receberam diazepam venoso como primeiro esquema terapeutico e ainda a associacao clorpromazina-fenotiazina, sem controle das crises convulsivas. Portanto, 54 pacientes, apos falha de um (29 casos) ou dois (25 casos) tratamentos anticonvulsivantes, receberam 1 g venoso de fenil-hidantoina diluida em soro fisiologico. A taxa de sobrevida materna foi de 85,2%, sendo que nao se obteve sedacao em oito casos que evoluiram para obito. O estudo anatomo-patologico de necropsia mostrou lesao pulmonar grave em sete casos e necrose de hipofise em tres. Tratando-se de pacientes tao graves, consideramos bom o resultado obtido e sugerimos o estudo da fenil-hidantoina empregada como primeira terapeutica sedativa na eclampsia